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Dr. Ascensión Doñate-Martínez
Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain

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0 Palliative Care
0 health policies
0 multimorbidity
0 patient-centred care
0 Population Ageing

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Preprint content
Published: 25 January 2021
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Background Palliative care (PC) has demonstrated benefits for life-limiting illnesses. Cancer patients have mainly accessed these services, but there is growing consensus about the importance of promoting access for patients with non-malignant disease. Bad survival prognosis and patient’s frailty are usual dimensions to decide PC inclusion. Objectives The main aim of this work is to design and evaluate three quantitative models based on machine learning approaches to predict frailty and mortality on older patients in the context of supporting PC decision making: one-year mortality, survival regression and one-year frailty classification. Methods The dataset used in this study is composed of 39,310 hospital admissions for 19,753 older patients (age >= 65) from January 1st, 2011 to December 30th, 2018. All prediction models were based on Gradient Boosting Machines. From the initial pool of variables at hospital admission, 20 were selected by a recursive feature elimination algorithm based on the random forest’s GINI importance criterion. Besides, we run an independent grid search to find the best hyperparameters in each model. The evaluation was performed by 10-fold cross-validation and area under the receiver operating characteristic curve and mean absolute error were reported. The Cox proportional-hazards model was used to compare our proposed approach with classical survival methods. Results The one-year mortality model achieved an AUC ROC of 0.87 ± 0.01; the mortality regression model achieved an MAE of 329.97 ± 5.24 days. The one-year frailty classification reported an AUC ROC of 0.9 ± 0.01. The Spearman’s correlation between the admission frailty index and the survival time was –0.1, while the point-biserial correlation between one-year frailty index and survival time was –0.16. Conclusions One-year mortality model performance is at a state-of-the-art level. Frailty Index used in this study behaves coherently with other works in the literature. One-year frailty classifier demonstrated that frailty status within the year could be predicted accurately. To our knowledge, this is the first study predicting one-year frailty status based on a frailty index. We found mortality and frailty as two weakly correlated and complementary PC needs assessment criteria. Predictive models are available online at http://demoiapc.upv.es.

ACS Style

Vicent Blanes-Selva; Ascensión Doñate-Martínez; Gordon Linklater; Juan M. García-Gómez. Development of quantitative frailty and mortality prediction models on older patients as a palliative care needs assessment tool. 2021, 1 .

AMA Style

Vicent Blanes-Selva, Ascensión Doñate-Martínez, Gordon Linklater, Juan M. García-Gómez. Development of quantitative frailty and mortality prediction models on older patients as a palliative care needs assessment tool. . 2021; ():1.

Chicago/Turabian Style

Vicent Blanes-Selva; Ascensión Doñate-Martínez; Gordon Linklater; Juan M. García-Gómez. 2021. "Development of quantitative frailty and mortality prediction models on older patients as a palliative care needs assessment tool." , no. : 1.

Journal article
Published: 16 April 2020 in Ageing and Society
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Living standards capabilities are an important determinant of healthy ageing. The Living Standards Capabilities for Elders scale (LSCAPE) is the main instrument available to assess living standards capabilities among older adults based on Sen's Capability Approach. The objectives of this study were: (a) to adapt and validate LSCAPE for use in the Spanish population; (b) to examine the dimensionality, validity and reliability; and (c) to establish the convergent validity of LSCAPE using self-reported measures of quality of life and income. The LSCAPE was administered to 441 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyse the dimensionality, validity and reliability. Discriminant and convergent validity of the model were assessed using Average Variance Extracted (AVE). Reliability was shown by Composite Reliability (CR) and Cronbach's alpha. Convergent validity was tested by correlating the LSCAPE scales and sub-scales with the Short-form Health Survey (SF-12) sub-scales. CFA showed that the LSCAPE Six-factor Model fits well to the data, showing Standardised Root Mean Square Residual < 0.09 (0.084), Comparative Fit Index and Tucker–Lewis Index > 0.9 (0.925 and 0.917, respectively). LSCAPE showed also good reliability (CR indices > 0.7) and validity (AVE > 0.5) measures. Finally, LSCAPE had moderate to strong associations with SF-12 sub-scales (>0.6) and a moderate relationship with income (>0.3). Thus, LSCAPE has been demonstrated to be a reliable and valid instrument in measuring living standards capabilities among the Spanish older population.

ACS Style

Tamara Alhambra-Borrás; Ascensión Doñate-Martínez; Jorge Garcés-Ferrer. The Living Standards Capabilities for Elders scale (LSCAPE): adaptation and validation in a sample of Spanish seniors. Ageing and Society 2020, 1 -13.

AMA Style

Tamara Alhambra-Borrás, Ascensión Doñate-Martínez, Jorge Garcés-Ferrer. The Living Standards Capabilities for Elders scale (LSCAPE): adaptation and validation in a sample of Spanish seniors. Ageing and Society. 2020; ():1-13.

Chicago/Turabian Style

Tamara Alhambra-Borrás; Ascensión Doñate-Martínez; Jorge Garcés-Ferrer. 2020. "The Living Standards Capabilities for Elders scale (LSCAPE): adaptation and validation in a sample of Spanish seniors." Ageing and Society , no. : 1-13.

Journal article
Published: 17 October 2017 in International Journal of Integrated Care
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Introduction: The activation of integrated care pathways is not always easy and is time-consuming, so the standardized use of stratification tools (ST) can support health care professionals in decision-making processes. Several ST –developed and validated in the United States– have been implemented in the Valencia Region (Spain) at primary care (PC) centres to identify elders with multimorbidity at risk of suffering future hospital admissions (FHA). In spite of the usefulness of these instruments, it would be recommended to apply STs which have been specifically designed on the basis of the Spanish healthcare system and the characteristics of its population. Thus, the objective of this study was to design a ST aimed at the identification of elders at risk of hospital admissions in the following 12 months in the Valencian Healthcare System. Methods: The study started with the organization of focus groups (FG) with six multidisciplinary PC professionals aimed at selecting potential variables to be included in the ST. From the FG’s results a retrospective study was carried out with the objective of identifying the most significant variables. These variables were tested in a sample of 107 elders. In the last stage, the combination of variables derived from the previous steps was tested in a sample of 1,000 patients in order to select a final combination of variables and to build a predictive algorithm through binary logistic regression analysis.Results: A set of 13 potential variables to be included in our ST were identified in the FG. These variables comprised data on socio-demographics, clinical and social aspects and registers on the previous use of health resources. As part of the retrospective studies, binary logistic regression analysis determined that the following variables were statistically significant as predictors of FHA: ‘chronic respiratory disease’ (OR= 2.32, p= 0.015), ‘chronic heart disease’ (OR= 2.10, p= 0.019), ‘palliative care’ (OR= 22.53, p= 0.04), and the ‘number of previous visits to emergency department at hospital’ (OR= 1.82, p< 0.001). The model derived a risk score from 0 to 1 for each patient, classifying patients as high risk of FHA at a risk score threshold of 0.5 or higher. The model had a sensitivity of 42% and specificity of 96% and the AUC was 0.76.Discussions: The model developed within this study has shown an optimal performance, and an acceptable ability to identify patients at high risk of FHA who really were admitted(sensitivity of 42%), an excellent ability to identify patients at low risk who really did not suffer any admission (specificity of 96%). The accuracy detecting patients was similar to other comparable studies or even higher with reported AUC of 0.764. Moreover, the model incorporates variables that can be collected automatically from electronic health information systems (eHIS). Furthermore, the experts participating in the FG highlighted some social variables – usually not registered within eHIS – as determinants of health, especially in elders with chronic conditions (such as availability of knowledge and skills for appropriate self-care, social and/or family support or economic difficulties). Thus, it is proposed a 2-phase stratification system: the first one will calculate the developed algorithm through eHIS, and the second one will assess social variables by consulting the professional of reference.Conclusions: The final predictive model is composed by variables available at eHIS, so it can be easily introduced into health administration system of the Valencia Region. From this screening and decision-making support ST, professionals will be able to implement a wide range of care plans in accordance with patients’ health and social needs which can potentially improve quality of care and favor that older people can remain at home longer.Lessons learned: It is possible to design new ST on the basis of the target population profile and the characteristics of the healthcare system.Limitations: The sample is not representative of the whole elderly population in the Valencia Region. Moreover, the sensitivity of the model is limited.Suggestions for future research: Future studies are needed to validate these results with a larger sample from the Valencia Region and other regions in Spain. Moreover, it would be interesting to explore their applicability in other health and social care settings and even in other European contexts assessing the degree of similarity or variance of discriminating factors or the available electronic data sets. Currently, we continue this study developing an integrated care protocol to be implemented in those patients identified as high risk of suffering FHA by a multidisciplinary team of PC professionals (general practitioners, nurses and social workers).

ACS Style

Ascensión Doñate-Martínez. Risk stratification at primary care centres in Valencia (Spain) to activate integrated care pathways for elderly patients with chronic conditions. International Journal of Integrated Care 2017, 17, 219 .

AMA Style

Ascensión Doñate-Martínez. Risk stratification at primary care centres in Valencia (Spain) to activate integrated care pathways for elderly patients with chronic conditions. International Journal of Integrated Care. 2017; 17 (5):219.

Chicago/Turabian Style

Ascensión Doñate-Martínez. 2017. "Risk stratification at primary care centres in Valencia (Spain) to activate integrated care pathways for elderly patients with chronic conditions." International Journal of Integrated Care 17, no. 5: 219.

Journal article
Published: 26 September 2015 in Archives of Gerontology and Geriatrics
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Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. The sample (n=74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users' inclusion. The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users' perceptions of satisfaction and usefulness were highly positive. Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels. Further adjustments are needed to address a comprehensive response to the needs of the global population of reference.

ACS Style

Ascensión Doñate-Martínez; Francisco Ródenas; Jorge Garcés. Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain). Archives of Gerontology and Geriatrics 2015, 62, 169 -175.

AMA Style

Ascensión Doñate-Martínez, Francisco Ródenas, Jorge Garcés. Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain). Archives of Gerontology and Geriatrics. 2015; 62 ():169-175.

Chicago/Turabian Style

Ascensión Doñate-Martínez; Francisco Ródenas; Jorge Garcés. 2015. "Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain)." Archives of Gerontology and Geriatrics 62, no. : 169-175.

Journal article
Published: 01 September 2014 in Archives of Gerontology and Geriatrics
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The Sustainable Social and Healthcare Model (SSHM) is aimed to establish new care pathways in primary care systems contributing to the decrease of health services use and costs and improve the integration and efficiency of social and health care for elderly people with long-term care (LTC) needs. One of these strategies is the segmentation of population in risk groups through standardized tools. This paper is a retrospective study aimed to determine the viability of the implementation of the screening tools Probability of Repeated Admission - Pra - and The Community Assessment Risk Screen - CARS - to detect patients at risk of hospital readmission in a sample of 500 elderly people (65+) from the VHS in Spain. Patients were recruited from three Health Departments. Data from selected tools and predictive variables were collected through the healthcare database from the VHS. The most important results indicate that both instruments predict with high efficacy the proportion of patients not readmitted (negative predictive value between 91% and 92%). Moreover, the tools performed with a moderate efficiency being the Pra less sensitive (54%) and more specific (81%) than CARS (with a sensitivity and specificity of 64%). Results from this study suggest that the application of instruments as Pra and CARS are of interest to the Valencian Health Administration as they can be a good strategy to improve the management of elderly patients at risk with comorbidities and guiding clinical decision.

ACS Style

Ascensión Doñate-Martínez; Jorge Garcés Ferrer; Francisco Ródenas Rigla. Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain). Archives of Gerontology and Geriatrics 2014, 59, 408 -414.

AMA Style

Ascensión Doñate-Martínez, Jorge Garcés Ferrer, Francisco Ródenas Rigla. Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain). Archives of Gerontology and Geriatrics. 2014; 59 (2):408-414.

Chicago/Turabian Style

Ascensión Doñate-Martínez; Jorge Garcés Ferrer; Francisco Ródenas Rigla. 2014. "Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain)." Archives of Gerontology and Geriatrics 59, no. 2: 408-414.

Journal article
Published: 01 February 2014 in Procedia - Social and Behavioral Sciences
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ACS Style

F. Ródenas; J. Garcés; E. Durá; A. Doñate-Martínez. Education and Training for Parents Today, Discipline and Wellbeing for Children Tomorrow. Procedia - Social and Behavioral Sciences 2014, 116, 2248 -2251.

AMA Style

F. Ródenas, J. Garcés, E. Durá, A. Doñate-Martínez. Education and Training for Parents Today, Discipline and Wellbeing for Children Tomorrow. Procedia - Social and Behavioral Sciences. 2014; 116 ():2248-2251.

Chicago/Turabian Style

F. Ródenas; J. Garcés; E. Durá; A. Doñate-Martínez. 2014. "Education and Training for Parents Today, Discipline and Wellbeing for Children Tomorrow." Procedia - Social and Behavioral Sciences 116, no. : 2248-2251.

Journal article
Published: 03 July 2013 in Procedia - Social and Behavioral Sciences
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The quality of parenting skills is fundamental to the children's well-being. The project “BE Supportive, NOT violent! Positive parenting for happy children!”, funded by the European Commission, proposes a new model of positive parenting to provide and reinforce parents’ knowledge, resources and tools to achieve a positive relationship and communication with their children. The model has been implemented twice with parents from Romania, Spain, Latvia, Poland, Italy and Sweden with positive results.

ACS Style

F. Ródenas; A. Doñate-Martínez; J. Garces. A New Educational Model to Train Parents for a Successful Upbringing of Children: A European Cross-national Study. Procedia - Social and Behavioral Sciences 2013, 82, 298 -301.

AMA Style

F. Ródenas, A. Doñate-Martínez, J. Garces. A New Educational Model to Train Parents for a Successful Upbringing of Children: A European Cross-national Study. Procedia - Social and Behavioral Sciences. 2013; 82 ():298-301.

Chicago/Turabian Style

F. Ródenas; A. Doñate-Martínez; J. Garces. 2013. "A New Educational Model to Train Parents for a Successful Upbringing of Children: A European Cross-national Study." Procedia - Social and Behavioral Sciences 82, no. : 298-301.

Journal article
Published: 28 June 2013 in Procedia - Social and Behavioral Sciences
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The aim of this study is to develop a tool to screen elders at risk of hospital readmissions adapted to Spanish target population. The development of this new tool is based on the validated instrument The Community Assessment Risk Screen – CARS –, which is being applied in a sample of 1.000 older patients. The adaptation and refinement of CARS is being carried out through the compilation of new potential variables from primary care clinicians to predict patients at risk of readmissions. The introduction of this new instrument adapted to Spanish target population will provide a potential tool to identify prematurel y patients at risk of hospital readmissions.

ACS Style

A. Doñate-Martínez; J. Garces; F. Ródenas. Adaptation and Refinement of Validated Risk Screening Tools in the Spanish Healthcare System. Procedia - Social and Behavioral Sciences 2013, 81, 100 -103.

AMA Style

A. Doñate-Martínez, J. Garces, F. Ródenas. Adaptation and Refinement of Validated Risk Screening Tools in the Spanish Healthcare System. Procedia - Social and Behavioral Sciences. 2013; 81 ():100-103.

Chicago/Turabian Style

A. Doñate-Martínez; J. Garces; F. Ródenas. 2013. "Adaptation and Refinement of Validated Risk Screening Tools in the Spanish Healthcare System." Procedia - Social and Behavioral Sciences 81, no. : 100-103.

Journal article
Published: 01 January 2013 in The International Journal of Interdisciplinary Organizational Studies
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ACS Style

Francisco Ródenas Rigla; Jorge Garcés Ferrer; Ascensión Doñate-Martínez. Innovation in the Management of Patients at Risk of Hospital Readmissions: New Technological Solutions To Promote Quality of Life in Older People. The International Journal of Interdisciplinary Organizational Studies 2013, 7, 31 -39.

AMA Style

Francisco Ródenas Rigla, Jorge Garcés Ferrer, Ascensión Doñate-Martínez. Innovation in the Management of Patients at Risk of Hospital Readmissions: New Technological Solutions To Promote Quality of Life in Older People. The International Journal of Interdisciplinary Organizational Studies. 2013; 7 (2):31-39.

Chicago/Turabian Style

Francisco Ródenas Rigla; Jorge Garcés Ferrer; Ascensión Doñate-Martínez. 2013. "Innovation in the Management of Patients at Risk of Hospital Readmissions: New Technological Solutions To Promote Quality of Life in Older People." The International Journal of Interdisciplinary Organizational Studies 7, no. 2: 31-39.